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County Health Department Operation Permit


									PIN ________________________________                                                   PERMIT NUMBER _________________________

                             County Health Department Operation Permit

SPECIFIC SYSTEM INSTALLED ______________________________________________________________________

System Type: ________       Types V and VI systems expire in 5 years. (In Accordance With Table Va )
Owner must contact health department 6 months prior to expiration for permit renewal.

_________________________________________________                         ________________________________________________
                       Owner’s Name                                                               System Installer
_________________________________________________                         ________________________________________________
                  Authorized State Agent                                                  Date of Operation Permit Issuance
This system has been installed in compliance with applicable NC General Statutes, Rules for Sewage Treatment and Disposal, and all conditions
of the Improvement Permit and Construction Authorization.

I. Performance:      System shall perform in accordance with Rule .1961.                II. Monitoring:      As required by Rule .1961.
III. Maintenance:    Ground absorption sewage treatment and disposal systems shall be checked, and the contents of the septic
tank removed, periodically from all compartments, to ensure proper operation of the system. The contents shall be pumped
whenever the solids level is found to be more than 1/3 of the liquid depth in any compartment.
Other:      __________________________________________________________
                     Subsurface system operator required? Yes _____ No _____
                     If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:       ______________________________________________________________________________________
V. Other:            ______________________________________________________________________________________

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